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First line chemotherapy with temozolomide (TMZ) in recurrent or progressive oligodendroglioma


Al Musella's Comments: (This is his personal views and are not necessarily the views of the Musella Foundation!)



Website: http://www.asco.org/ac/1,1003,_12-002489-00_18-002003-00_19-00102850-00_29-00A,00.asp?cat=CNS+Tumors&parent=Central+Nervous+System+Tumors&returnpid=2325&SubCat_ID=4

Posted on: 06/14/2003

39th ASCO Annual Meeting • Chicago, IL • May 31-June 3, 2003 (Abstract No. 426)

First line chemotherapy with temozolomide (TMZ) in recurrent or progressive oligodendroglioma

A. A. Brandes, U. Basso, F. Vastola, L. M. Pasetto, S. Lonardi, A. Scola, G. Ravenna, B. Coria, F. Chioffi, M. Ermani

Dept Medical Oncology, Az Osp-Universita, Padova, Italy; Department of Neurosurgery, Verona, Italy; Dept Medical Oncology,San Bortolo Hosp, Vicenza, Italy; Department of Neurological Sciences, Padova, Italy

Sixty to seventy-five percent of oligodendroglial tumors respond to PCV chemotherapy which, however, incurs substancial acute and delayed toxicity. TMZ is an effective second line chemotherapy with manageable toxicity, but more data are required to establish whether it could replace PCV as standard first line chemotherapy.

Objectives: To evaluate the RR, TTP and toxicity following first line TMZ administration in patients with oligodendroglioma.

Methods: Pts considered eligible were chemonaive, with a centrally reviewed pathological diagnosis of oligodendroglioma (OD) or oligo-astrocytoma (OA), progressive or recurrent after radiotherapy, with at least one contrast enhancing lesion measuring ³ 1cm of diameter. Pts were treated with 150-200 mg/m2 TMZ on days 1 to 5, every 28 days. Tumor response was evaluated according to Macdonald's criteria.

Results: Thirty-two pts were included in the study (median age 49 yrs, range 27-63 yrs; KPS 80, range 60-90; 21 OD). Twenty-eight pts were evaluable: 4 CR (14%) and 9 PR (32%) were obtained, 9 pts (32%) were stable for more than two months. The median TTP was 12 months. The PFS at 6 and 12 months were 67% (CI 95%= 52-87%) and 45% (CI 95%= 29-70%) respectively; in responders these percentages were 83 (CI 95%=64-100%) and 58 (CI 95%= 36-94%), respectively. A total of 225 cycles of TMZ were administered (median 7). Toxicity was mainly hematological, with grade 3-4 neutropenia and thrombocytopenia in 4 (12.5%) and 3 (9.3%) pts, respectively. No extra-hematological grade 3-4 side effects were reported, except for nausea and vomiting G3 in 3 (9.3%) pts. In 6 pts (18.7%) TMZ dosage was reduced to 150 mg/m2 because of reversible hematological toxicity. Of the progressing 18 pts, 14 have started second line chemotherapy with PCV and 10 are evaluable for response: 1 CR and 2 PR (RR: 33%) plus 4 SD were obtained, with a PFS-6 and PFS-12 of 40 and 30%, respectively.

Conclusions: In recurrent oligodendroglioma, the activity of temozolomide as first line chemotherapy is similar to that of PCV. Furthermore it has a greater tolerability and incurs no cross-resistance with PCV chemotherapy.

© Copyright 2003 American Society of Clinical Oncology All rights reserved worldwide



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